What are the goals of treating pediatric asthma?

For many years improvement in symptoms and normalization of lung function have been the main goals in treatment of pediatric asthma. Recently, other parameters, such as reductions in frequency and severity of exacerbations, reduced mortality, normalization of airway hyperresponsiveness, reduction in chronic inflammation of the airways and airway remodeling, normal development of lung function, and normal psychosocial development, are thought to be of similar, or possibly greater, importance. The present understanding of the effects of various drugs used for asthma control is at an early stage. For example, excellent control of one outcome measure may be achieved by a particular drug without any effect on other outcome measures, and the dose of drug needed to control one outcome measure may be quite different from the dose required to control others. Furthermore, the time course of the effect of a drug on the various parameters can differ for each parameter. Improvements in lung function and symptoms often precede, and even reach a plateau, before the maximum reduction in responsiveness is observed. This makes it difficult to determine whether all the goals have been achieved. Therefore, treatments and doses that have been shown in controlled trials to improve most outcome measures are preferred, but their side-effect profiles must also be considered. The majority of parameters seem to be related to the degree of airway inflammation. Unfortunately, at present, the tools of measure all aspects of airway inflammation in the day-to-day management of asthma are not available. Also, the degree to which the inflammatory process must be suppressed, or which aspects of inflammation need to be controlled, to influence the various parameters is not known.